>My more important point is that if a drug maker had 75 years to exclusively market their compound as opposed to 20 (give or take 8-12 for the current approval process), the cost to the consumer would plummet.

I disagree, for a couple of reasons:

1. Exclusivity gives zero incentive to lower prices. Prices of patent medicines never "plummet" until generics enter the market. That doesn't happen until the patent/exclusivity expires (de jure or de facto).

2. Maybe you're referring to recovery of (admittedly large) up-front R&D costs, over the longer time period. From a finance POV this should be viewed as an amortization. Depending of course on the interest rate chosen, the yearly repayment of that up-front cost will drop much less than 20/75, and likely can't be reasonably considered a "plummet". Anyone who's ever held a mortgage knows the monthly payments don't change that much when changing the amortization period from, say, 25 years to 35 years, let alone to 75 years.

>In addition, we'd likely see many more of the orphaned drugs being developed as they would have a much better chance at profitability.

As I see it, currently there are several barriers to development of treatments for uncommon or rare conditions:

1. Competition for R&D funding from other treatments that are more "mainstream" and offer a better ROI

2. Relatedly, limitations on the total pool of available R&D funding. My understanding is health care in the US currently consumes something like 12% of GDP, and pharma R&D is a not insignificant fraction of that

3. Limitations on key personnel - there are only so many scientists, doctors etc. capable of undertaking pharma R&D

I don't think extending exclusivity from 20 to 75 years will significantly affect any of the above.